An Update on the Senate Health Reform Debate

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The Senate health reform bill is in a procedural holding pattern right now. Even though the body will be in session over the weekend, Majority Leader Harry Reid has put off votes on the bill while he waits for the Congressional Budget Office to evaluate a new Democratic proposal that could strip the public option out of the bill. In my story today, I explore the ramifications of one part of that plan – expanding Medicare eligibility to include Americans 55-64.

But just because the Senate is stalled doesn’t mean time has stopped. On the contrary, there are a few important things happening right now on the health care reform front.

1. Democratic Senators Ron Wyden and Evan Bayh have teamed up with moderate Republican Senator Susan Collins to offer a package of meaningful amendments. (I emphasize meaningful here because, as I’ve been noting, many of the amendments to the Senate bill are “message amendments” or “sense of the Senate” amendments that have no actual effect.) The Wyden-Bayh-Collins package, on the other hand, is worthy of examination because it represents a genuine act of bipartisanship and could alter the bill in meaningful ways. The most notable amendment in the package is the so-called “Free Choice Amendment” that Wyden has been pushing all year. Ezra Klein, the Washington Post’s resident health policy wonk, has a description of the idea here. The quick explanation, though, is that the Free Choice Amendment would allow workers to opt out of their employer-sponsored health insurance and instead get a voucher from their employer to shop around for coverage. While a majority of Americans get health insurance through their jobs, the system as it exists is unsustainable and Wyden argues it’s unfair and unwise to prohibit workers from going outside that system.

2. The Associated Press dropped a bit of a policy bombshell today, reporting that Reid quietly inserted language into the Senate health reform bill that would allow insurers to limit the annual amount they spend on benefits. The bill from the Senate Health, Education, Labor and Pensions committee, according to the AP, did not have such a limit. This is important. Cancer patients, for example, can bump up against these kinds of caps and, in effect, end up without coverage long before their treatment is complete. One of the oft-touted insurance market reforms in the Democrats’ health plan is a rule to prohibit insurers from placing a lifetime limit on benefits. It’s not clear how an annual limit has less of an effect than a lifetime effect. Of course, the flip side is that allowing insurers to cap benefits ends up lowering premiums for everyone.

3. The chief actuary for the Centers for Medicare and Medicaid Services, an arm of the Department of Health and Human Services, released a report last night evaluating the Reid Senate bill. Republican Senators have been citing the CMS report as proof that the Democratic bill is a fiscal disaster, but that’s a mischaracterization. The CMS actuary did say the bill would make health expenditures go up, but that’s because more people are expected to have better insurance and therefore will be able to afford more care. The New Republic’s Jonathan Cohn has a good read on the CMS report here.

4. I wrote earlier this week about an amendment spearheaded by Democrat Byron Dorgan that would allow for the “reimportation” of pharmaceuticals from foreign countries. This proposal would go against a deal the White House made with the drug industry and so it’s caused no small amount of consternation. Democrats are divided over the plan. Things have gotten so dicey that Sen. Jay Rockefeller, who is a co-sponsor of the Dorgan amendment, has said he will vote against it. Read more here and here.